APPLICATION. Associate of Applied Science Degree in Nursing LPN to RN Bridge Program Rolla (for current LPNs)

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APPLICATION

for

Associate of Applied Science Degree in Nursing

LPN to RN Bridge Program

Rolla

(for current LPNs)

Class Beginning: January, 2017

Graduating: December, 2017

Deadline to apply: August 1, 2016

**NOTE: A new application must be submitted each year.

NOTICE OF NON-DISCRIMINATION:

Applicants for admission and employment, students, employees, and sources of referral of applicants for admission and employment are hereby notified that East Central College does not discriminate on the basis of race, color, religion, national origin, ancestry, gender, sexual orientation, genetic information, age, disability, veteran status or any other characteristic protected by law. Inquiries related to employment practices may be directed to Wendy Hartman, Human Resources Director, 005 Classroom Building MP, telephone number 636-584-6712 or [email protected].

Inquiries/concerns regarding civil rights compliance as it relates to student programs and services may be directed to the Vice President of Student Development, 131 Buescher Hall, 636-584-6565 or [email protected]. Both offices are located at the ECC main campus located at 1964 Prairie Dell Road, Union, Missouri 63084.

2 ASSOCIATE DEGREE NURSING PROGRAM

RN Bridge Program (for current LPN’s) UNION AND ROLLA

Thank you for your interest in our Associate Degree Nursing Program. Enclosed is the application packet. This packet includes information you will need to read and forms you will need to complete and return if you would like to begin the application process.

East Central College offers a LPN to RN Bridge program leading to an Associate of Applied Science Degree in nursing. The program is designed to provide the student who holds a Missouri LPN license the educational mobility to complete the RN classes in a format that specifically meets the needs of the working LPN.

The East Central College Associate Degree Nursing Program is fully approved by the Missouri State Board of Nursing. As identified in the packet, it is a 71 credit hour program that encompasses on-campus classroom and laboratory hours as well as clinical experience in a variety of local hospitals and facilities. Bridge students will have classroom and clinical lab times at both Union and Rolla locations. Students can expect some travel to both locations throughout the program. Once selected for admission into the LPN to RN Bridge program, students should complete the fulltime nursing program in one calendar year. General education courses may be completed on a full- or part-time basis prior to entering the program. Upon graduation, students receive an Associate of Applied Science Degree in Nursing (ADN) and are eligible to sit for the national exam (NCLEX) to obtain a Registered Nurse (RN) license. A generic nursing program is available for those LPN’s desiring a more traditional course of study (a different application must be obtained).

An Associate of Applied Science Degree in Nursing is the first step in professional nursing. This degree prepares you to begin further studies (through University Programs) to progress in the profession for a Bachelor of Science Degree in Nursing, a Master’s Degree in Nursing, or a Doctoral Degree, if you choose to do so.

To be considered for admission into East Central College’s Associate Degree Nursing (ADN) program you must have completed high school, or equivalent, and be admitted as an East Central College student (separate application). Applicants desiring admission into the RN program, who have failed to achieve a “C” or better in ANY two nursing ECC nursing courses or in 2 of ANY RN nursing program(s) attended, will not be considered for admission. Also, students who have been admitted two times to ANY RN program(s) are not eligible for admission. To apply to the nursing program, return the attached application to East Central College, Attn: Brenda Garrison, 1964 Prairie Dell Road, Union, MO 63084-4344, with receipt from the Business Office at the Union campus or the ECC office located on the Rolla Technical Center campus (500 Forum Drive, Rolla) showing payment of the $15.00 application fee. Applications must be submitted on an annual basis; they are only good for one admission cycle.

If you have any questions, contact Brenda Garrison, Program Assistant for Nursing and Allied Health, at (636)584-6616 or via e-mail [email protected]. Nursing program information is also available on our website at

http://www.eastcentral.edu/nursing/nursing/.

APPLICATION DEADLINE: The ECC Nursing Program is approved to accept students into the program each Spring semester. The deadline for applications to be complete, with all checklist items completed, is August 1st _{the year before your} desired entrance into the Nursing Program and application files close on August 31st_.

Class selection is based on academic performance. A point system is used to determine an applicant’s rank in the selection process. Your academic advisor is glad to review your standing and provide suggestions on how you may achieve the best candidacy possible.

For consideration, applicants must meet the following minimum criteria:

3 2. HESI A2 Admission Test Score of 75% or higher in the last two years.

The HESI A2 Test is designed to assess a student’s academic and personal readiness for higher education in a healthcare related field, such as nursing. The test is an internet-based, timed (plan for 4-1/2 hours), multiple choice test evaluating your knowledge in the following categories: English language, grammar, vocabulary, math, biology, and critical thinking. Estimated time for each section is provided by Elsevier below but tests are not individually timed during testing. You will have 4-1/2 hours to complete the test so pacing yourself is very important. You will

schedule your exam in the Learning Center for Union students and at ECC Rolla Main at 500 Forum Drive for Rolla students. The exam is administered only at the Union campus. The ECC HESI A2 Fact Sheet has more

information about the Admission Test requirement and dates given. The HESI A2 Fact Sheet and the Nursing Admission Test Registration form may be found on our website at http://www.eastcentral.edu/nursing/nursing/. 3. Presentation of a current, undisciplined, PN license with IV certification to practice in Missouri, or documented

eligibility to write the NCLEX-PN, and two (2) years of recent clinical experience or be a new LPN graduate with LPN employment.

4. Provide proof of malpractice insurance with a minimum amount of $1,000,000/5,000,000, once accepted to program.

5. Successful completion of NR1024 Successful Transitions in Nursing course (offered only in Fall semester) which includes the requirement of successful completion of HESI LPN to RN Mobility Exam with a composite score of 700 or greater in 2 attempts. This course has a two-year time limit for program pre-requisite.

6. Pre-requisite coursework completed with a “C” or better. Pre-requisite coursework must be completed by the

end of the Fall semester (December) before Spring admission into the program.

7. Three (3) appropriate references on file. (See application for guidelines regarding references.)

8. Official transcripts received and evaluated for program as well as proof of enrollment, if coursework is taken at another institution. High school and/or GED transcripts are included. Applications will not be considered if official transcripts have not been received and evaluated by August 31st_{. It is the applicant’s responsibility to check}

their E-Central account to determine status of their ECC transcript.

9. Must be in a state of physical and mental health compatible with the responsibilities of a nursing career. A physical examination, including selected diagnostic tests and immunizations, is required after acceptance (a form is provided in acceptance packet).

10. Admission is contingent upon a successful criminal background check and a satisfactory drug screening. The procedures are completed after the nursing acceptance packet has been received.

It is the applicant’s responsibility to verify with the Nursing and Allied Health office that the application file is complete. Incomplete application files will not be considered for admission.

All college coursework, pertinent to the nursing program, MUST be completed with a grade of “C” or better. All science courses must be no older than 5 years at the time of acceptance.

All applicants will be notified, in writing, of their admission status by October 30th _{each year. An appointment may} be made by calling (636) 584-6616 (Union) or (573) 202-6950 (Rolla). You may also e-mail:

[email protected] or [email protected].

Best of luck with your educational endeavors and please let us know if we can be of assistance.

Robyn C. Walter, MSN, RN

ECC Nursing Program Director

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CHECKLIST FOR ADMISSION TO THE ASSOCIATE DEGREE IN NURSING

NOTE: Students who have ever been admitted to any Nursing Program previously must produce a Letter of Recommendation from the previous Nursing Dean/Director. A student who has failed to achieve a “C” or better in ANY two core nursing courses, in any RN nursing program(s) attended, will not be considered for admission. Students who have been readmitted one time to ANY RN program are not eligible for admission.

To INITIATE the application process, the student MUST complete the following requirements:

______ 1. APPLY FOR GENERAL ADMISSION TO THE COLLEGE - (Declare Major: Pre-Nursing). Call or visit Student Services to obtain an Application for Admission and to receive information on the college admissions process. The number is (636-584-6588). Applications are also available on our website:

www.eastcentral.edu.

______ 2. COMPLETE THE APPLICATION FOR NURSING - Submit the completed application in this package to the Nursing and Allied Health Division Office, Health Science Building Suite 105 or to the Nursing Building in Rolla (Rolla North) at 2303 N. Bishop. A copy of the HESI A2 test scores should be included as well as the two signature pages after the application.

______ 4. SUCCESSFUL COMPLETION OF ALL PRE-REQUISITE COURSEWORK with a grade of “C” or better. Pre- requisite coursework must be completed by the end of the Fall semester (December) before Spring admission into the program.

______ 3. PROVIDE OFFICIAL HIGH SCHOOL, TECHNICAL SCHOOL & COLLEGE TRANSCRIPTS - Applicant must request that official transcripts from high school or GED (scores required) and all colleges attended be sent to ECC Student Services for evaluation. Evaluating transcripts can be time consuming so please allow ample time for processing. Failure to request your transcripts in a timely manner may result in an incomplete application file. We must have your official LPN transcripts on file.

______ 4. NURSING ADMISSION TEST:

HESI A2 ADMISSION TEST: - Applicants must successfully complete the HESI A2 Pre-Admission Test for RN programs. The HESI A2 may be taken no more than twice in an application cycle. A minimum score of seventy-five percent (75%) as a composite is required. It is comprised of exams that are academically oriented, consisting of math, reading comprehension, grammar and vocabulary, biology, and critical thinking. Included in this packet is information on the exam, the study guide and how to apply to take it. It is your responsibility to provide the office with a copy of your examination scores.

______ 5. CUMULATIVE COLLEGE GRADE POINT AVERAGE (GPA) OF 2.75 (MINIMUM) as of August 31st _{on a} minimum of 12 credit hours of college credit.

______ 6. THREE COMPLETED APPROPRIATE REFERENCES (see nursing application and reference form for criteria); the applicant is responsible for distributing references. It is the applicant’s responsibility to check with the nursing office to make sure that the references have been returned by the August 31st _deadline.

______7. SUCCESSFUL COMPLETION OF NR1024 Successful Transitions in Nursing course which includes the requirement of successful completion of HESI LPN to RN Mobility Exam with a composite score of 700 or greater in 2 attempts. This course is offered each Fall semester in an 8-week format.

______ 8. SIGNED TECHNOLOGY ACKNOWLEDGEMENT FORM

______ 9. SIGNED PERFORMANCE STANDARDS ACKNOWLEDGEMENT FORM

UPON ACCEPTANCE INTO THE NURSING PROGRAM THE FOLLOWING WILL BE REQUIRED: ______ 1. PROOF OF MALPRACTICE INSURANCE with a minimum amount of $1,000,000/5,000,000. ______ 2. DRUG SCREENING (site determined by ECC)

______ 3. MEDICAL EXAMINATION - with Satisfactory Results (Departmental form provided). Must be in a state of physical and mental health compatible with the responsibilities of a nursing career. A physical examination (at the student’s cost), including selected diagnostic tests and immunizations, is required after acceptance (a form is provided in acceptance packet)

______ 4. SATISFACTORY FINGERPRINT/CRIMINAL BACKGROUND CHECK

______ 5. CURRENT CPR CARD - From either American Heart Association (BCLS-C) for Healthcare Provider (Basic Cardiac Life Support), or the American Red Cross CPR for the Professional Rescuer.

______ 6. PRESENTATION OF A CURRENT, UNDISCIPLINED, PN LICENSE with IV certification to practice in Missouri, or documented eligibility to write the NCLEX-PN, and two (2) years of recent clinical experience or be a new LPN graduate with LPN employment.

5 NOTE TO ALL STUDENTS: It is the RESPONSIBILITY of the STUDENT to MAINTAIN COMMUNICATION

WITH the Nursing and Allied Health office to ensure that their application folder is complete and up-to-date with current admission requirements. You may call (636) 584-6616 or e-mail [email protected] or

[email protected]. Admission to the program is competitive in nature and is not guaranteed. A selection committee ranks all applications and admission is granted to the most qualified applicants. Applicants can improve their chances of admission by maintaining a high GPA, completing pre- and co-requisite courses and scoring high on the nursing entrance exam. It should be understood that satisfactorily meeting minimum requirements does not automatically guarantee admission. APPLICATION DEADLINES: The Nursing Application is due by August 1st _{prior to the Spring semester in which you}

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East Central College

Associate Degree Nursing Program

Summary of ECC Nursing Drug Screening, Immunization and Physical Examination Policies

Criminal History

As a requirement of the application process for the East Central College Nursing Program, in response to RSMo 660.317b and 660.315, students accepted into the program will be required to consent to release of their criminal history records (RSMo 43.450) for the sole purpose of determining the applicant’s ability to enter patient care areas in order to fulfill the requirements of the Nursing program. Any student who is found to have a criminal history for a felony conviction, as defined by state law, or is found to be on one of the governmental sanction lists, will not be accepted nor allowed to continue enrollment in the ECC Nursing Program. Acceptance into and completion of the program does not guarantee licensure. In addition, any conviction may affect a student’s ability to be placed in a clinical site and a graduate’s ability to sit for the NCLEX RN Examination or attain State Licensure.

Drug Screening

The purpose of the ECC Nursing Program Drug Testing Policy is to ensure that students entering the Program are drug- and alcohol-free and to comply with the Drug-Free Schools and Communities Act Amendments of 1989. Offers of acceptance to the Nursing Program are made as conditional offers. Applicants may be denied admittance if a positive drug screen is detected. An applicant who refuses to authorize and pay for testing, or who tests positive for drugs, alcohol, or controlled substances, may not receive a final offer of admission. A current Nursing student who refuses to authorize and pay for testing, or who tests positive for drugs, alcohol, or controlled substances, may not be allowed to continue in the Nursing program. A positive drug screen during the professional years may disqualify a student from participating in required coursework involving client interaction and will affect the student’s ability to complete the program.

Immunizations and Physical Examination

The purpose of the ECC Nursing Program Immunizations and Physical Examination Policy is to ensure that students entering the Program are in a state of physical and mental health compatible with the responsibilities of a career in nursing and in general, working with individuals in a healthcare or other provider environment. Upon acceptance to the program, all incoming nursing students are required to have a physical examination and certain immunizations (forms will be provided) to comply with ECC and clinical site-specific policies. Record of childhood immunizations are sufficient; however, if not available or insufficient, proof of immunity/re-immunization is required at the student’s expense. Applicants may be denied admittance if they are not in a state of physical and mental health compatible with the responsibilities of a career as a registered nurse and/or if they do not receive the proper immunizations.

Graduate Learning Outcomes

Upon completion of the ECC Nursing Program, the graduate will be eligible to sit for the NCLEX RN licensure exam. Upon passing the exam, graduates will be licensed as a registered nurse in the State of Missouri. See Performance Standards on page 17 for more information.

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EAST CENTRAL COLLEGE

ASSOCIATE DEGREE NURSING PROGRAM

LPN to RN Bridge Curriculum

East Central College requires the following general education courses for an Associate of Applied Science Degree in Nursing. It is the responsibility of each applicant to COMPLETE these course requirements PRIOR to beginning the Nursing program.

~~Any request for a waiver of program pre-requisites must be approved in writing by the Director of Nursing.~~

ALL SCIENCE CLASSES MUST BE NO MORE THAN 5 YEARS OLD WITH A GRADE OF "C" OR BETTER!

SPRING SEMESTER Credit Hours

NR2014/2035 Nursing of Adults & Children II Lecture/Lab 10

FALL SEMESTER

NR2045/2055 Nursing of Adults & Children III Lecture/Lab 10

NR2991 Nursing Trends/Employment Skills 1

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Progression Policy: Students in the final semester are required to take a standardized RN Exit Exam. Achievement of an acceptable score is required for successful completion of the program. Details are published in the Student Nursing Handbook (obtained after acceptance).

NOTE: In order to achieve success in the nursing program, a student is expected to spend an additional average of 20-30 hours per week studying and preparing. Some examples include: practicing skills in the clinical lab, preparing for clinical assignments, studying for exam, preparing for class, developing written assignments, and developing presentations (not an inclusive list). Student can expect to spend 2-3 contact hours per credit hour for clinical lab courses.

PREREQUISITE COURSEWORK

NR1024 Successful Transitions in Nursing 4

(meets FS1001 Foundations Seminar requirement)

MT1303 Intermediate Algebra 3

PS1203 American Gov’t or HI1103, HI1203 or HI1303 American History 3 (HI1000 -Constitution Module must be completed with this course for credit)

EN1223 English Composition I 3

EN1333 English Composition II 3

BI2104 Anatomy and Physiology I Lecture and Lab 4

BI2115 Anatomy and Physiology II Lecture and Lab 5

BI1314 Microbiology for Allied Health Lecture and Lab 4

*PY2403 Human Development 3

32 Prerequisites for Human Development:

--English Composition I

--PY1103 General Psychology 3

Prerequisites for HAP I, HAP II, Microbiology Lec/Lab: -- Lab Safety Course

-- CH1105 Intro. to Chemistry 5

-- BI1305 General Biology Lecture and Lab 5

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EAST CENTRAL COLLEGE

ASSOCIATE DEGREE NURSING PROGRAM

PREREQUISITES: In-District @ $95.00/hr. (35 credit hours) = $3,325.00 Out-of-District @ $139.00/hr. (35 credit hours) = $4,865.00

An application fee of $15.00 is due when applying. When accepted, an admission packet fee of $75.00 is due.

IN-DISTRICT OUT-OF-DISTRICT SPRING, Second semester: 10 credit hours

Tuition/Support Services/Student Activity/Technology Fees Special Lab/Assessment Fee

Books and Syllabi (approximate)

$1,140.00 375.00 900.00 $1, 580.00 375.00 900.00 TOTAL SPRING SEMESTER $ 2,415.00 $ 2,855.00 FALL, Fourth semester: 11 credit hours

Tuition/Support Services/Student Activity/Technology Fees Special Lab/Assessment Fee

Books and Syllabi (approximate)

State Board of Nursing Exam Fee (approximate cost) NCLEX-RN National Exam (approximate cost) Graduation Pin (approximate minimum cost) NCLEX-RN Prep Course (Student’s responsibility)

$ 1,254.00 375.00 225.00 120.00 300.00 50.00 425.00 $ 1,738.00 375.00 225.00 120.00 300.00 50.00 425.00 TOTAL FALL SEMESTER $ 2,949.00 $ 3,358.00 Total Nursing Coursework: $ 5,364.00 $ 6,213.00 Total Prerequisites/General Education (does not include books, etc.) 3,325.00 4,865.00 TOTAL Program Cost: $ 8,689.00 $ 11,078.00

PLEASE NOTE: Effective Fall, 2015 semester, nursing courses will have the Tier 2 differential tuition rate. Tier 2

tuition (with student fees): In-District - $114/ch; Out-of-District - $158/ch.

*The cost of prerequisites includes tuition, technology, support services and student activity fees only.

**ALL costs are estimated and intended only to give a general idea. Amounts are subject to change during the time allotted for the degree. You pay only for credit hours taken in a given semester.

**All web-hybrid courses at ECC have a $30.00 fee charge. Fall, 2015 Rates/Updated: March, 2016

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EAST CENTRAL COLLEGE

ASSOCIATE DEGREE NURSING PROGRAM

NURSE PRACTICE ACT

Completion of the East Central College Associate Degree Nursing Program does not guarantee eligibility to write the NCLEX. Therefore, it is our responsibility to inform students who will be applying to write the Missouri State Board Test Pool Examination for licensure as registered nurses of the following portion of the Nurse Practice Act of Missouri:

335.066. Denial, revocation, or suspension of license, grounds for, civil immunity for providing information--complaint procedures.

1. The board may refuse to issue or reinstate any certificate of registration or authority, permit or license required pursuant to chapter 335 for one or any combination of causes stated in subsection 2 of this section or the board may, as a condition to issuing or reinstating any such permit or license, require a person to submit himself or herself for identification, intervention, treatment, or rehabilitation by the impaired nurse program as provided in section 335.067 . The board shall notify the applicant in writing of the reasons for the refusal and shall advise the applicant of his or her right to file a complaint with the

administrative hearing commission as provided by chapter 621.

2. The board may cause a complaint to be filed with the administrative hearing commission as provided by chapter 621 against any holder of any certificate of registration or authority, permit or license required by sections 335.011 to 335.096 or any person who has failed to renew or has surrendered his or her certificate of registration or authority, permit or license for any one or any combination of the following causes:

(1) Use or unlawful possession of any controlled substance, as defined in chapter 195, or alcoholic beverage to an extent that such use impairs a person's ability to perform the work of any profession licensed or regulated by

sections 335.011 to 335.096 ;

(2) The person has been finally adjudicated and found guilty, or entered a plea of guilty or nolo contendere, in a criminal prosecution pursuant to the laws of any state or of the United States, for any offense reasonably related to the qualifications, functions or duties of any profession licensed or regulated pursuant to

sections 335.011 to 335.096 , for any offense an essential element of which is fraud, dishonesty or an act of violence, or for any offense involving moral turpitude, whether or not sentence is imposed;

(3) Use of fraud, deception, misrepresentation or bribery in securing any certificate of registration or authority, permit or license issued pursuant to sections 335.011 to 335.096 or in obtaining permission to take any examination given or required pursuant to sections 335.011 to 335.096 ;

(4) Obtaining or attempting to obtain any fee, charge, tuition or other compensation by fraud, deception or misrepresentation;

(5) Incompetency, gross negligence, or repeated negligence in the performance of the functions or duties of any profession licensed or regulated by chapter 335. For the purposes of this subdivision, "repeated negligence"

means the failure, on more than one occasion, to use that degree of skill and learning ordinarily used under the same or similar circumstances by the member of the applicant's or licensee's profession;

(6) Misconduct, fraud, misrepresentation, dishonesty, unethical conduct, or unprofessional conduct in the

performance of the functions or duties of any profession licensed or regulated by this chapter, including, but not limited to, the following:

(a) Willfully and continually overcharging or overtreating patients; or charging for visits which did not occur unless the services were contracted for in advance, or for services which were not rendered or documented in the patient's records;

(b) Attempting, directly or indirectly, by way of intimidation, coercion or deception, to obtain or retain a patient or discourage the use of a second opinion or consultation;

(c) Willfully and continually performing inappropriate or unnecessary treatment, diagnostic tests, or nursing services;

(d) Delegating professional responsibilities to a person who is not qualified by training, skill, competency, age, experience, or licensure to perform such responsibilities;

(e) Performing nursing services beyond the authorized scope of practice for which the individual is licensed in this state;

(f) Exercising influence within a nurse-patient relationship for purposes of engaging a patient in sexual activity; (g) Being listed on any state or federal sexual offender registry;

(h) Failure of any applicant or licensee to cooperate with the board during any investigation;

(i) Failure to comply with any subpoena or subpoena duces tecum from the board or an order of the board; (j) Failure to timely pay license renewal fees specified in this chapter;

10 (k)Violating a probation agreement, order, or other settlement agreement with this board or any other licensing

agency;

(l) Failing to inform the board of the nurse's current residence;

(m) Any other conduct that is unethical or unprofessional involving a minor;

(7) Violation of, or assisting or enabling any person to violate, any provision of sections 335.011 to 335.096 , or of any lawful rule or regulation adopted pursuant to sections 335.011 to 335.096 ;

(8) Impersonation of any person holding a certificate of registration or authority, permit or license or allowing any person to use his or her certificate of registration or authority, permit, license or diploma from any school;

(9) Disciplinary action against the holder of a license or other right to practice any profession regulated by

sections 335.011 to335.096 granted by another state, territory, federal agency or country upon grounds for which revocation or suspension is authorized in this state;

(10) A person is finally adjudged insane or incompetent by a court of competent jurisdiction;

(11) Assisting or enabling any person to practice or offer to practice any profession licensed or regulated by sections 335.011to 335.096 who is not registered and currently eligible to practice pursuant to

sections 335.011 to 335.096 ;

(12) Issuance of a certificate of registration or authority, permit or license based upon a material mistake of fact; (13) Violation of any professional trust or confidence;

(14) Use of any advertisement or solicitation which is false, misleading or deceptive to the general public or persons to whom the advertisement or solicitation is primarily directed;

(15) Violation of the drug laws or rules and regulations of this state, any other state or the federal government; (16) Placement on an employee disqualification list or other related restriction or finding pertaining to employment within a health-related profession issued by any state or federal government or agency following final

disposition by such state or federal government or agency; (17) Failure to successfully complete the impaired nurse program;

(18) Knowingly making or causing to be made a false statement or misrepresentation of a material fact, with intent to defraud, for payment pursuant to the provisions of chapter 208 or chapter 630, or for payment from Title XVIII or Title XIX of the federal Medicare program;

(19) Failure or refusal to properly guard against contagious, infectious, or communicable diseases or the spread thereof; maintaining an unsanitary office or performing professional services under unsanitary conditions; or

failure to report the existence of an unsanitary condition in the office of a physician or in any health care facility to the board, in writing, within thirty days after the discovery thereof;

(20) A pattern of personal use or consumption of any controlled substance unless it is prescribed, dispensed, or administered by a provider who is authorized by law to do so;

(21) Habitual intoxication or dependence on alcohol, evidence of which may include more than one alcohol-related enforcement contact as defined by section 302.525 ;

(22) Failure to comply with a treatment program or an aftercare program entered into as part of a board order, settlement agreement, or licensee's professional health program.

3. After the filing of such complaint, the proceedings shall be conducted in accordance with the provisions of chapter 621. Upon a finding by the administrative hearing commission that the grounds, provided in subsection 2 of this section, for disciplinary action are met, the board may, singly or in combination, censure or place the person named in the complaint on probation on such terms and conditions as the board deems appropriate for a period not to exceed five years, or may suspend, for a period not to exceed three years, or revoke the license, certificate, or permit.

4. For any hearing before the full board, the board shall cause the notice of the hearing to be served upon such licensee in person or by certified mail to the licensee at the licensee's last known address. If service cannot be accomplished in person or by certified mail, notice by publication as described in subsection 3 of section 506.160 shall be allowed; any representative of the board is authorized to act as a court or judge would in that section; any employee of the board is authorized to act as a clerk would in that section.

5. An individual whose license has been revoked shall wait one year from the date of revocation to apply for relicensure. Relicensure shall be at the discretion of the board after compliance with all the requirements of

sections 335.011 to 335.096relative to the licensing of an applicant for the first time.

6. The board may notify the proper licensing authority of any other state concerning the final disciplinary action determined by the board on a license in which the person whose license was suspended or revoked was also licensed of the suspension or revocation.

11 7. Any person, organization, association or corporation who reports or provides information to the board of nursing pursuant to the provisions of sections 335.011 to 335.259* and who does so in good faith shall not be subject to an action for civil damages as a result thereof.

8. The board may apply to the administrative hearing commission for an emergency suspension or restriction of a license for the following causes:

(1) Engaging in sexual conduct ** as defined in section 566.010 , with a patient who is not the licensee's spouse, regardless of whether the patient consented;

(2) Engaging in sexual misconduct with a minor or person the licensee believes to be a minor. "Sexual misconduct" means any conduct of a sexual nature which would be illegal under state or federal law;

(3) Possession of a controlled substance in violation of chapter 195 or any state or federal law, rule, or regulation, excluding record-keeping violations;

(4) Use of a controlled substance without a valid prescription;

(5) The licensee is adjudicated incapacitated or disabled by a court of competent jurisdiction;

(6) Habitual intoxication or dependence upon alcohol or controlled substances or failure to comply with a treatment or aftercare program entered into pursuant to a board order, settlement agreement, or as part of the licensee's professional health program;

(7) A report from a board-approved facility or a professional health program stating the licensee is not fit to practice. For purposes of this section, a licensee is deemed to have waived all objections to the admissibility of testimony from the provider of the examination and admissibility of the examination reports. The licensee shall sign all necessary releases for the board to obtain and use the examination during a hearing; or

(8) Any conduct for which the board may discipline that constitutes a serious danger to the health, safety, or welfare of a patient or the public.

9. The board shall submit existing affidavits and existing certified court records together with a complaint alleging the facts in support of the board's request for an emergency suspension or restriction to the administrative hearing commission and shall supply the administrative hearing commission with the last home or business addresses on file with the board for the licensee. Within one business day of the filing of the complaint, the administrative hearing commission shall return a service packet to the board. The service packet shall include the board's complaint and any affidavits or records the board intends to rely on that have been filed with the administrative hearing commission. The service packet may contain other information in the discretion of the administrative hearing commission. Within twenty-four hours of receiving the packet, the board shall either personally serve the licensee or leave a copy of the service packet at all of the licensee's current addresses on file with the board. Prior to the hearing, the licensee may file affidavits and certified court records for consideration by the administrative hearing

commission.

10. Within five days of the board's filing of the complaint, the administrative hearing commission shall review the information submitted by the board and the licensee and shall determine based on that information if probable cause exists pursuant to subsection 8 of this section and shall issue its findings of fact and conclusions of law. If the administrative hearing commission finds that there is probable cause, the administrative hearing commission shall enter the order requested by the board. The order shall be effective upon personal service or by leaving a copy at all of the licensee's current addresses on file with the board. 11. (1) The administrative hearing commission shall hold a hearing within forty-five days of the board's filing of the complaint to determine if cause for discipline exists. The administrative hearing commission may grant a request for a

continuance, but shall in any event hold the hearing within one hundred twenty days of the board's initial filing. The board shall be granted leave to amend its complaint if it is more than thirty days prior to the hearing. If less than thirty days, the board may be granted leave to amend if public safety requires.

(2) If no cause for discipline exists, the administrative hearing commission shall issue findings of fact, conclusions of law, and an order terminating the emergency suspension or restriction.

(3) If cause for discipline exists, the administrative hearing commission shall issue findings of fact and conclusions of law and order the emergency suspension or restriction to remain in full force and effect pending a disciplinary hearing before the board. The board shall hold a hearing following the certification of the record by the administrative hearing commission and may impose any discipline otherwise authorized by state law.

12. Any action under this section shall be in addition to and not in lieu of any discipline otherwise in the board's power to impose and may be brought concurrently with other actions.

12 13. If the administrative hearing commission does not find probable cause and does not grant the emergency suspension or restriction, the board shall remove all reference to such emergency suspension or restriction from its public records. Records relating to the suspension or restriction shall be maintained in the board's files. The board or licensee may use such records in the course of any litigation to which they are both parties. Additionally, such records may be released upon a specific, written request of the licensee.

14. If the administrative hearing commission grants temporary authority to the board to restrict or suspend the nurse's license, such temporary authority of the board shall become final authority if there is no request by the nurse for a full hearing within thirty days of the preliminary hearing. The administrative hearing commission shall, if requested by the nurse named in the complaint, set a date to hold a full hearing under the provisions of chapter 621 regarding the activities alleged in the initial complaint filed by the board.

15. If the administrative hearing commission refuses to grant temporary authority to the board or restrict or suspend the nurse's license under subsection 8 of this section, such dismissal shall not bar the board from initiating a subsequent disciplinary action on the same grounds.

16. (1) The board may initiate a hearing before the board for discipline of any licensee's license or certificate upon receipt of one of the following:

(a) Certified court records of a finding of guilt or plea of guilty or nolo contendere in a criminal prosecution under the laws of any state or of the United States for any offense involving the qualifications, functions, or duties of any profession licensed or regulated under this chapter, for any offense involving fraud, dishonesty, or an act of violence, or for any offense involving moral turpitude, whether or not sentence is imposed;

(b) Evidence of final disciplinary action against the licensee's license, certification, or registration issued by any other state, by any other agency or entity of this state or any other state, or the United States or its territories, or any other country;

(c) Evidence of certified court records finding the licensee has been judged incapacitated or disabled under Missouri law or under the laws of any other state or of the United States or its territories.

(2) The board shall provide the licensee not less than ten days' notice of any hearing held pursuant to chapter 536. (3) Upon a finding that cause exists to discipline a licensee's license, the board may impose any discipline otherwise available.

(L. 1975 S.B. 108 § 12, A.L. 1981 S.B. 16, A.L. 1995 S.B. 452, A.L. 1999 H.B. 343, A.L. 2007 H.B. 780 merged with S.B. 308, A.L. 2013 H.B. 315)

*Section 335.259 was repealed by S.B. 52, 1993. **Word "in" appears here in original rolls.

13

Associate Degree Nursing Program

Admission Ranking

RANKING FOR ADMISSION

HESI EXAM GPA References LPN Transcript

LPN to RN Mobility Exam* (Individual Composite Score) 75 = 0 76-79 = 2 80-85 = 4 86-90 = 6 91-94 = 8 95-100 = 10 Accumulated college GPA of a minimum of 12 credit hours of college credit 2.75 = 0 2.76 – 2.9 = 2 3.0 – 3.5 = 4 3.6 – 4.0 = 6 References are evaluated according to the following responses:

Excellent Above Average Average Below Average Grades from Fundamentals, Med-Surg, and Pharmacology A = 2 B = 1 C = 0 (Individual Scores) 700-750 = 0 751-800 = 1 801-850 = 2 851-900 = 3 Above 900 = 4 *Administered during successful Transitions in Nursing. A minimum score of 700 is required for admission.

**NOTE: Admission criteria is subject to change; however, all applicants will be notified of changes

should they occur.

14 RETURN APPLICATION (with receipt for

$15 application fee), by August 1, 2015 TO:

EAST CENTRAL COLLEGE ***Deadline for all Bridge applications: August 1, 2016

Brenda Garrison, Program Assistant File must be complete by: August 31, 2016

ADN Program

1964 Prairie Dell Road APPLICATION FOR ADMISSION TO:

Union, MO 63084-4344 LPN to RN Bridge ADN Program – Rolla

Telephone: (636) 584-6616

Completion of this application does not constitute admission to the program of study.

NAME: _______

Last First MI Previous or Other Names Student ID Number

ADDRESS:

Street City State Zip Code County

Home Phone: _______________________ Work/School Phone: E-Mail:______________________________

(Falcon e-mail address)

Person to be notified in case of emergency:

Name: __________________________________________________________Relationship: _____________________________ Address: ___________________________________________________________________ Phone: _______________________

EDUCATION:

High School Attended: ______________________________________________________Year Graduated

OR, Earned GED: State: _______________________________________Date Received: __________________ COLLEGE/PROFESSIONAL SCHOOL(S) ATTENDED:

NAME: ____________________________________Dates Attended_________________________Degree___________________ NAME: ____________________________________Dates Attended_________________________Degree___________________ NAME: ____________________________________Dates Attended_________________________Degree___________________

If you are currently attending college, list the courses being taken: ____

____

PROFESSIONAL REFERENCE INSTRUCTIONS: Please fill in the following information. Three (3) references are required by August 31st _{for a completed application file. One reference must be from current employer and one reference from LPN}

instructor. Please note: It is your responsibility to contact references and distribute the enclosed reference form to those individuals, with a stamped envelope addressed with the ECC Nursing address above. Your references should be by a professional, other than a relative, who can attest to your character and work ethic; preferably a healthcare professional. ***Students that have been previously enrolled in a nursing program or are requesting nursing transfer must supply one reference from the Dean/Director of that program.

NAME (First and Last) PLEASE PRINT LEGIBLY

STREET/BOX ADDRESS/CITY/STATE/ZIP (Must have complete addresses. If business address, please include name of business.)

TITLE/ POSITION

RELATIONSHIP (No friends or family)

APPLICATION FOR ADMISSION

January 2017

OFFICE USE ONLY Receipt # _____________________ Received by: ___________________ Date Rec’d: _____________________

15 WORK HISTORY: List employment beginning with the most recent position.

NAME OF EMPLOYER ADDRESS POSITION HELD DATES

From To

**If yes, explain fully, in a separate notarized statement, and provide certified copies of court documents (i.e. docket sheet, complaint, and final disposition).

YES NO

Have you ever been convicted, adjudged guilty by a court, pled guilty, pled nolo contendere or entered an Alford plea to any crime, whether or not sentence was imposed excluding traffic violations? (This includes any crime where the disposition was a suspended imposition of sentence (SIS), or a suspended execution of sentence (SES), or if you pled guilty but were placed in an alternative or diversion court, including drug or DWI court.)

YES NO

Have you ever been convicted, adjudged guilty by a court, pled guilty, pled nolo contendere or entered an Alford plea to any traffic offense resulting from or related to the use of drugs or alcohol, whether or not sentence was imposed? (This includes a disposition of a suspended imposition of sentence (SIS), suspended execution of sentence (SES), or placement in a post-plea alternative or diversion court and includes municipal charges of driving while intoxicated, driving under the influence and/or driving with excessive blood alcohol content.)

YES NO

Do you have any condition or impairment, including a history of alcohol or substance abuse that currently interferes, or if left untreated may interfere, with your ability to practice in a competent and

professional manner? If yes, explain fully in a separate notarized statement.

YES NO

Are you now being treated, or have you been treated within the past five years, through a drug or alcohol

rehabilitation program? If yes, explain fully in a separate notarized statement and provide the

discharge summary or other official documentation that shows your diagnosis, prognosis, and treatment plan.

YES NO

Are you listed on any state or federal sexual offender registry? If yes, explain fully on a separate

notarized statement.

YES NO

Have you ever been placed on an employee disqualification list or other related restriction of finding pertaining to employment within a health-related profession issued by any state or federal government or

agency? If yes, explain fully on a separate notarized statement.

Any student who is found to have a criminal history for a class A or class B felony, as defined by state law, or is found to be on one of the governmental sanction lists, will not be able to continue enrollment in the East Central College Nursing program. Acceptance into, and completion of the program, does not guarantee licensure by the Missouri State Board of Nursing. If criminal history prohibits placement in the clinical setting, you will not be able to complete the nursing program at East Central College.

Admission is contingent upon a successful criminal background check and a satisfactory drug screening. The procedures are completed after the initial acceptance letter is sent.

I understand that all information contained in this application, high school, college or university transcripts, together with the information received from references, will be presented to an admissions committee for review. I hereby grant permission to have my records reviewed.

In applying for admission to a nursing program at East Central College, I hereby _______waive my right of access or, I hereby _____do not waive my right of access, to confidential letters and statements of recommendation submitted by references on my behalf as provided by Federal Law, PL93-380.

List all states in which you have resided in the past 10 years. _______________________________________________ ________________________________________________________________________________________________ By signing this application, I understand that it is my responsibility to check the completion status of my

application file no later than August 31st _{before the year of desired program entrance. The file must be complete} for consideration. I also understand that any falsification of this application will result in ineligibility for

admission and/or continuation of the East Central College Nursing. ___________________________________

Date Signature

(For office use) LPN License Number______________ Date Granted______________ Verified by_____________

16

East Central College

Associate Degree Nursing Program

Acknowledgement of Technology Requirements Form

To the applicant: Review this form to indicate you understand the technology requirements of the Nursing Program. Sign

and return the form with your nursing application by the August 1

_deadline.

The East Central College Nursing Program utilizes e-technologies to deliver a portion of course content and as

a means of communication with program students, faculty and staff. Through a combination of didactic

coursework, classroom/laboratory practice, and clinical experiences, students will learn the profession of

nursing. Aspects of all of these learning environments will require familiarity with internet-based technologies.

In addition to internet based technologies, interactive television will also be utilized to convey course content

for some course content between the Union Campus and Rolla location. Some specialty topics have a

significant portion delivered with this technology. This allows students to experience the highest level of

nursing expertise for instructional purposes.

Offers of acceptance to the ECC Nursing Program are made as conditional offers. In addition, to the

satisfactory completion of pre-requisite courses, a satisfactory background check, and a negative alcohol, drug,

and/or controlled substance test, applicants are required to acknowledge the integral use of technology in the

delivery of this program. Technologies include, but are not limited to: internet, e-mail, Moodle, interactive

television (ITV), online database searching, web-based lecture capture, internet streaming video review, and

other e-technologies as assigned as integral components of the Nursing Program. While many of these

technologies are accessible through any computer with access to the internet, students may be required to travel

to the Union campus or Rolla location to attain consistent, high-speed access compatible with viewing of

content-specific materials. Students are also required to attend classes on campus delivered through the ITV

format.

Students are NOT required to have a personally-owned computer or home-based high speed internet access as

these materials and services are made readily available at either the Union or Rolla location. However, current

nursing students report that personally owned laptop computers and access to high speed internet connections

in their homes leads to increased satisfaction and a more convenient and accessible learning environment.

I have read and understand the above technology requirements related to the ECC Nursing Program and

hereby acknowledge that in order to successfully complete the program I will need to utilize said technologies

for communication with program faculty and staff, access to course content, assignment submission, and

dialogue with fellow classmates and colleagues in these virtual environments.

Name (Please Print): _____________________________________________________________

Signature: ____________________________________________Date: _____________________

17

East Central College

Associate Degree Nursing Program

Performance Standards for Associate Degree Nursing Students

To the applicant: Review and sign this page to indicate you understand the performance standards listed on the next page. Return the signed page with your application materials by the August 1st _deadline.

Student Responsibilities:

Registered nurses (RN’s) promote health, prevent disease, and help patients and families cope with illness. They have a unique scope of practice, yet work collaboratively with all members of the healthcare team. Nurses are hands-on professionals who provide focused and highly personalized care. Registered nurses assess a patient’s health, help perform diagnostic tests and analyze results; operate medical equipment; administer a variety of treatments and medications; and assist with patient follow-up and rehabilitation. They develop and manage a nursing plan of care and instruct patients and families on issues of health promotion, disease prevention, and disease management. Nurses also serve as advocates for patients, families, and communities.

A majority of registered nurses practice in hospitals, though a growing number are employed in long-term care settings, community- based facilities such as outpatient surgery centers and rehabilitation centers. Others work in community health, industrial or school nursing, clinics, and physician offices. The field has a wide range of opportunities ranging from entry-level practitioner to doctoral-level researcher/practitioner. During your academic experience, you will be exposed to learning environments which are challenging and reflective of job demands typical of future practice as Registered Nurse. Your education also includes clinical work at varying facilities which will involve direct client contact and involvement with community professionals. Compliance and demonstration of performance skills related to physical as well as professional standards of practice are a requirement for successful completion of the ECC Nursing Program.

Students are expected to follow professional standards set by the ECC Nursing Program and to conduct themselves in an ethical and responsible manner with other students, faculty, administrators, community professionals and clients, equipment, and supplies.

Performance Standards for Successful Completion of the Nursing Program:

These Performance Standards should be used to assist each applicant and student to determine if they are otherwise qualified to be a Registered Nurse. It is the policy of East Central College to provide reasonable accommodations for individuals with disabilities. If you need an accommodation due to a disability under the Americans with Disabilities Act, please contact the Access Office at (636) 584-6581, prior to applying to the ECC nursing program.

Progression Policy:

Students in the final semester of the program are required to take a standardized RN Exit Exam. Achievement of an acceptable score is required for successful completion of the program. Details are published in the Student Nursing Handbook (obtained after acceptance and available on the nursing website).

Upon completion of the Associate of Applied Science degree in Nursing, the graduate will be able to meet the standards outlined in this application.

I acknowledge receiving, reading, understanding, and meet the Nursing Performance Standards and the Missouri State Board of Nursing licensure requirements. I realize that these Performance Standards must be met for successful completion of the ECC Nursing Program. I further understand that completion of the ECC Nursing Program does not guarantee licensure with Missouri State Board of Nursing (MSBN).

Student Name (printed legibly): ____________________________________________________________________

Student Signature: ________________________________________________Date: __________________________

NOTE: Students who do not meet Performance Standards or MSBN requirements may not be eligible for the ECC Nursing Program. Any applicant who is concerned about being eligible for licensure may discuss this matter with the Nursing Program Director by contacting the Allied Health office at (636) 584-6616 for an appointment.

18

EAST CENTRAL COLLEGE - ASSOCIATE DEGREE NURSING CORE

PERFORMANCE STANDARDS FOR ADMISSION AND PROGRESSION

ISSUE

STANDARD

EXAMPLES OF NECESSARY ACTIVITIES (Not All

Inclusive)

Critical Thinking Critical thinking ability sufficient for clinical judgment

• Identify cause-effect relationships in clinical situations • Develop nursing care plans

• Make rapid decisions under pressure

• Handle multiple priorities in stressful situations • Assist with problem solving

Interpersonal

Interpersonal abilities sufficient to interact with individuals, families, and groups from a variety of social, educational, cultural, and intellectual backgrounds

• Establish rapport with patients/clients and colleagues • Cope effectively with high levels of stress

• Cope with anger/fear/hostility of others in a calm manner • Cope with confrontation

• Demonstrate high degree of patience Communication

Communication abilities sufficient for interaction with others in verbal and written form

• Explain treatment procedures • Initiate client education

• Document and interpret nursing actions and patient/client responses

Mobility

Physical abilities sufficient to move from room to room, to maneuver in small spaces and to perform procedures necessary for emergency intervention

• Move around in patient’s rooms, workspaces, and treatment areas

• Administer cardio-pulmonary resuscitation procedures • Walk the equivalent of 5 miles per day

• Remain on one’s feet in upright position at a workstation without moving about

• Climb stairs

• Remain in seated position

Motor Skills Gross and fine motor abilities sufficient to provide safe and effective nursing care

• Calibrate and use equipment • Position patients/clients • Perform repetitive tasks • Able to grip

• Bend at knee and squat. • Reach above shoulder level • Lift and carry 25 pounds

• Exert 20-50 pounds of force (pushing/pulling) Hearing Auditory ability sufficient to monitor and

assess health needs

• Hear monitor alarms, emergency signals, auscultatory sounds, and cries for help

• Hear tape recorded transcriptions • Hear telephone interactions Visual Visual ability sufficient for observation and

assessment necessary in nursing care

• Observe patient/client responses • Identify and distinguish colors Tactile Tactile ability sufficient for physical

assessment

• Perform palpation, functions of physical examination and/or those related to therapeutic intervention, e.g., insertion of a catheter

Environmental Ability to tolerate environmental stressors

• Adapt to shift work

• Work with chemicals and detergents • Tolerate exposure to fumes and odors • Work in areas that are close and crowded

19

Associate Degree Nursing Program

P r o f e s s i o n a l R e c o m m e n d a t i o n F o r m

Please complete this section and then present this form to the recommender along with a stamped envelope addressed to East Central College Nursing Program (the address is in top right corner). As an alternative, the recommender may return the form to you in a sealed envelope for you to submit with your application packet. Forms should be completed by a professional reference, other than a relative, who can attest to your character and work ethic; preferably a healthcare professional.

PLEASE NOTE: Applicant files close August 31st_{. Applications will not be reviewed unless recommendations are on file by the}

deadline.

Section B: To the Recommender:

The above individual has applied to the East Central College Associate Degree Nursing Program. Graduates of the ECC ADN Program are expected to pursue careers in the nursing field. Your assessment of their potential is essential in the process used for selection of final candidates.

Relationship to applicant? ______________________________ How long have you known this applicant?_______________ Please carefully assess the applicant in the following areas, comparing this applicant to others you have known who have similar levels of experience or education.

Criteria Excellent Above

Average Average

Below Average

Unable to Judge Communication Skills: (Command of oral and written language, use of

appropriate body language)

Reliability/Integrity: (Honest; trustworthy; conscientious)

Motivation: (Committed based on mature values; realistic view of profession) Maturity: (Self-control, unselfish, realistic self-appraisal)

Perseverance: (Steadfast in purpose; disciplined work habits; stamina/endurance) Interpersonal Relations: (Effective response/sensitivity to feelings/needs of others) Emotional Stability: (Performance under pressure; absence of tension symptoms;

mood stability)

Intellectual Ability: (Capable of understanding new ideas and concepts) Resourcefulness: (Adaptable in new situations; effective use of resources) Judgment: (Ability to analyze a situation and make appropriate decisions)

Please share any additional strengths, weaknesses or concerns that the selection committee should consider for this candidate (please use back of page for additional space):

Recommender Signature: ___________________________________________ Date: Please Print Name:

Thank you for taking the time to provide a reference for this potential nursing student.

Name:

Last Maiden (if applicable) First Middle Initial

WAIVER OPTION: In applying for admission to the nursing program at East Central College, this student agrees to waive their Right of Access, as provided by Federal Law, PL93-380, to confidential letters and statements of recommendation submitted by references on their behalf as constituted by their signature below. If no signature is given, the student will have the right to read this reference.

Applicant’s Signature _________________________________________________ Date

Please mail by Aug. 15

_to:

Attn: Nursing Department 1964 Prairie Dell Road Union, MO 63084

20

Associate Degree Nursing Program

P r o f e s s i o n a l R e c o m m e n d a t i o n F o r m

Please complete this section and then present this form to the recommender along with a stamped envelope addressed to East Central College Nursing Program (the address is in top right corner). As an alternative, the recommender may return the form to you in a sealed envelope for you to submit with your application packet. Forms should be completed by a professional reference, other than a relative, who can attest to your character and work ethic; preferably a healthcare professional.

PLEASE NOTE: Applicant files close August 31st_{. Applications will not be reviewed unless recommendations are on file by the}

deadline.

Section B: To the Recommender:

The above individual has applied to the East Central College Associate Degree Nursing Program. Graduates of the ECC ADN Program are expected to pursue careers in the nursing field. Your assessment of their potential is essential in the process used for selection of final candidates.

Relationship to applicant? ______________________________ How long have you known this applicant?_______________ Please carefully assess the applicant in the following areas, comparing this applicant to others you have known who have similar levels of experience or education.

Criteria Excellent Above

Average Average

Below Average

Unable to Judge Communication Skills: (Command of oral and written language, use of

appropriate body language)

Reliability/Integrity: (Honest; trustworthy; conscientious)

Motivation: (Committed based on mature values; realistic view of profession) Maturity: (Self-control, unselfish, realistic self-appraisal)

Perseverance: (Steadfast in purpose; disciplined work habits; stamina/endurance) Interpersonal Relations: (Effective response/sensitivity to feelings/needs of others) Emotional Stability: (Performance under pressure; absence of tension symptoms;

mood stability)

Intellectual Ability: (Capable of understanding new ideas and concepts) Resourcefulness: (Adaptable in new situations; effective use of resources) Judgment: (Ability to analyze a situation and make appropriate decisions)

Please share any additional strengths, weaknesses or concerns that the selection committee should consider for this candidate (please use back of page for additional space):

Recommender Signature: ___________________________________________ Date: Please Print Name:

Thank you for taking the time to provide a reference for this potential nursing student.

Name:

Last Maiden (if applicable) First Middle Initial

WAIVER OPTION: In applying for admission to the nursing program at East Central College, this student agrees to waive their Right of Access, as provided by Federal Law, PL93-380, to confidential letters and statements of recommendation submitted by references on their behalf as constituted by their signature below. If no signature is given, the student will have the right to read this reference.

Applicant’s Signature _________________________________________________ Date

Please mail by Aug. 15

_to:

Attn: Nursing Department 1964 Prairie Dell Road Union, MO 63084